A national panel of medical experts proposed significant and costly changes for training new doctors in the nation’s hospitals, recommending mandatory sleep breaks and more structured shift changes to reduce the risk of fatigue-related errors.
The report, issued by the Institute of Medicine, focused on the grueling training of medical residents, the recent medical school graduates who care for patients under the supervision of a fully-licensed physician. The medical residency, which aims to educate doctors by fully immersing them in a particular specialty and all aspects of patient care, is characterized by heavy patient workloads, 80-hour workweeks and sleep deprivation.
But while popular television shows like “Grey’s Anatomy” glamorize residency training as a gratifying rite-of-passage for doctors, the worry is that the massive workload imposed on residents poses a risk to patient safety. The grueling hours of often unsupervised residents were found to have contributed to the 1984 death of 18-year-old Libby Zion in New York, a finding that eventually led to a series of reforms, including limiting residents to an 80-hour workweek and 30-hour shifts. Read more…
Lately, I’ve been reading a fascinating new book, “Hippocrates’ Shadow: Secrets From the House of Medicine” (Simon & Schuster, 2008), which explores the entrenched subculture of doctors and medical practice. The author, Dr. David H. Newman, is an emergency medicine physician at St. Luke’s-Roosevelt Hospital Center in New York who was also deployed in Iraq in 2005. The book focuses on the missteps of modern medicine, but it begins with a fascinating look back at where it all began. Here is an excerpt.
By David H. Newman, M.D.
By today’s standards, Hippocrates was a profoundly abnormal physician. Medicine’s founding father routinely tasted his patients’ urine, sampled their pus and earwax, and smelled and scrutinized their stool. He assessed the stickiness of their sweat and examined their blood, their phlegm, their tears, and their vomit. He became closely acquainted with their general disposition, family, and home, and he studied their facial expressions.
In deciding upon a final diagnosis and treatment, Hippocrates recorded and considered dietary habits, the season, the local prevailing winds, the water supply at the patient’s residence, and the direction the home faced. He absorbed everything, examining exhaustively and documenting meticulously.
Modern-day physicians often cringe or shake their heads when they hear descriptions of Hippocrates’ diagnostic methods; laypeople, however, have quite a different response — they wonder aloud at how nice it might be to have Hippocrates as their doctor. Read more…
Often patients visit the doctor with a litany of symptoms and the hope that the doctor can give them a diagnosis.
But as Dr. Pauline W. Chen notes in her “Doctor and Patient” column today, a diagnosis doesn’t always lead to better care. The problem, she notes, is that once doctors settle on a diagnosis, they start treating that specific disease, rather than always listening to the specific problems of the patient in front of them. The illness may have a name, but the patient has become anonymous. Dr. Chen writes:
Over the last century and a half, however, medicine has increasingly decoupled disease from the individual. This decoupling has given rise to the concept of precise, objective and quantifiable diagnoses, diagnoses so separate from patients that they seem in many ways to take on a life of their own…. When we know what is wrong, we sometimes stop paying such close
attention to those patient experiences that seem to have little relevance to the diagnosis at hand. We focus less on the individual and more on the diagnosis.
To read more, check out today’s fascinating “Doctor and Patient” column: “The Tyranny of Diagnosis.”
Have you been frustrated by the medical community’s inability to diagnose your ailment? Did your care improve once doctors were able to put a label on your problems? Please join Dr. Chen in the discussion by sharing your thoughts and experiences below.
Do clothes make the doctor? Or do they just increase infection rates? That’s the debate that is brewing in England, where new rules about doctors’ attire are raising questions about clothing and patient confidence.
In January, the National Health Service instituted a new dress code, banning ties and asking doctors to wear short sleeves. The “bare below the elbows” rule is aimed at reducing hospital infections — shirt sleeves and ties are known to accumulate germs as doctors move from patient to patient.
But an article in the medical journal BJU International questions the validity of the dress code, saying there’s little evidence that the “bare below the elbows” rule will reduce infection rates, and that patients may be less confident in a tie-less doctor sporting short sleeves. Read more…
Ordering the wrong test, missing results and forgetting to notify patients are among the many testing mistakes that occur routinely at the offices of family doctors, a new study shows.
The report, published in the journal Quality & Safety in Health Care, looked at testing procedures and mistakes that were reported anonymously by 243 doctors, nurses and staff members in eight small and large family physician practices in seven states. During an eight-month period, researchers from the University of Chicago analyzed the error reports related to medical testing, including ones they observed “should not have happened and that you don’t want to happen again.” The tests included lab work, diagnostic imaging and other procedures like pulmonary function tests and electrocardiograms.
Nearly 1,000 testing mistakes involving 590 patients were reported during the collection period. Read more…
Dr. Robert Lamberts, the August, Ga., physician who wrote the original rules in his blog, Musings of a Distractible Mind, says it was easy to criticize his own profession, but it’s tough to turn the spotlight on patients. That said, patients are half of the doctor-patient relationship, and they need a few rules of their own. Here are his six rules for patients.
Rule 1: Your doctor can’t do it alone.
The best doctor can do very little with patients who ignore instructions. Sometimes noncompliance is partly due to physicians not explaining things well, but medical compliance is ultimately in the hands of the patient. I am mystified as to why some patients will ignore nearly everything I say and yet continue coming in for regular appointments.
Why are patients mad at doctors? Maybe, suggests medical blogger Dr. Robert Lamberts, it’s because doctors aren’t following the rules.
Doctors have always been a hot topic of discussion on the Well blog. We’ve talked about the rocky relationship between doctors and patients, a doctor’s disdain for medical Googlers, and whether doctors should lecture patients about their weight. And every time, hundreds of readers comment about how frustrated they are with doctors and the medical system.
Dr. Lamberts, an Augusta, Ga., physician and writer of Musings of a Distractible Mind, notes that he has a few simple rules that help him get along better with his patients. Read more…
After a series of recent blog posts about doctors and patients, I’ve been surprised at the level of animosity many patients seem to have for their doctors.
The simmering distrust of the medical system — and the doctors who work in it — are the topic of my Well column this week, as well as a new Well video, “Do You Trust Doctors?” (see below). For their part, doctors aren’t at all surprised patients are angry.
Video
“They have every right to be angry, and by the way, so do physicians,” said Dr. David H. Newman, a Manhattan emergency physician and author of the book “Hippocrates’ Shadow.”
“It’s not at each other,” Dr. Newman continued. “It’s almost never about the human being on the other end of the stethoscope. It’s almost always about a lack of communication and system pressures pushing away from the actual relationship, the human bond which is more powerful than the medications we use every day.”
To read the full Well column, click here. And please post your thoughts below.
Many patients give cards, baked goods and other gifts to show appreciation to a favorite doctor. Today, two well-known wine columnists write about giving doctors the gift of wine.
The gift of wine. (Tony Cenicola/The New York Times)
When visiting the doctor, “we have noticed three items almost always on display: medical certificates, pictures of lovely families and at least one bottle of wine,” write Dottie Gaiter and John Brecher in the popular Tastings column in The Wall Street Journal. “We never thought much about the wine…until we asked a physician recently why he had an unusual bottle of California wine on his shelf right next to the plastic model of the intestines.”
As it turns out, the bottle was a much-appreciated gift from a grateful patient. As a result, the Tastings writers conducted their own informal survey, asking doctors around the country whether they have received gifts of wine from patients. Read more…
After seeing an overweight patient with a back problem, Dr. Robert Lamberts of Augusta, Ga., decided to blog about it. Last week, I linked to his blog and asked readers “Should Doctors Lecture Patients About Their Weight?”
More than 700 of you responded. Many readers were grateful that Dr. Lamberts seemed to understand their plight. Others offered their own stories of being lectured by doctors.
“If shaming and being a social pariah was sufficient to get people to lose weight, there would be no fat people,” wrote reader Jill. “The stress of dealing with fat-hatred is, I believe, a bigger threat to health than weight is.”
Dr. Lamberts thinks it’s counterproductive to “scold” patients about their weight. “It makes people not want to come into the office,” he said. “They don’t want to walk into scorn.”
To hear more from Dr. Lamberts and his views on helping patients with weight issues, listen to the podcast below.
Overweight people already know they are overweight. So should doctors keep nagging them to lose pounds?
No surprises here. (PictureNet/Corbis)
That’s the issue tackled recently by one of my favorite medical blogs, called “Musings of a Distractible Mind.” The author, who goes by “Dr. Rob,” is Dr. Robert Lamberts, an Augusta, Ga., physician who is board certified in internal medicine and pediatrics. On his blog, Dr. Rob muses about a variety of topics like llamas, twinkies and favorite patients. But I was particularly moved by a recent post, which was written after Dr. Rob’s encounter with an overweight patient who was clearly accustomed to being lectured about obesity. As Dr. Rob was about to discuss whether the man needed surgery for sciatica and back pain, the patient interrupted him, hanging his head in shame and blaming his weight for the problem. Read more…
The Well blog has been busy the past week with comments from patients frustrated with their doctors, and doctors frustrated with their patients.
“Don’t blame the patient — I don’t know why I don’t lose weight, and neither do you. But I wish you’d get over thinking I lie to you because I don’t. And I do listen, but you have nothing new to say,” wrote Catdancer.
“I’m a medical student right now, graduating in a year, and from reading these posts the future doesn’t look promising. The field of medicine has changed in ways I couldn’t imagine. Not only are legal and financial strains making it harder and harder for us to practice, but patients are becoming increasingly more distrusting of the care we provide….
Doctors speak their minds. (Sabina Louise Pierce for The New York Times)
Reader’s Digest recently asked two dozen doctors to talk about what’s on their minds. The result: a litany of complaints, insights and observations about patients and medicine.
Here are some of their thoughts:
• I am utterly tired of being your mother. Every time I see you, I have to say the obligatory, “You need to lose some weight.” But you swear you “don’t eat anything” or “the weight just doesn’t come off,” and the subject is dropped. Then you come in here complaining about your knees hurting, your back is killing you, your feet ache and you can’t breathe when you walk up half a flight of stairs. So I’m supposed to hold your hand and talk you into backing away from that box of Twinkies. Boy, do I get tired of repeating the stuff most patients just don’t listen to.
— Cardiologist, Brooklyn, N.Y. Read more…
Hospital waiting room. (Thomas McDonald for The New York Times)
Nearly 30 years ago, public relations expert Larry Ragan wrote about his experience navigating the medical system and offered his own advice for how hospitals should treat patients.
Mr. Ragan died in 1995 from Lou Gehrig’s disease, but the Web site of his firm, Ragan Communications, today republished the June 1980 essay. What’s so surprising — and troubling — is how little has changed in medical care in three decades. Among Mr. Ragan’s suggestions:
Get rid of half your wheelchairs. If you do, you will use them only for those who need them, thus freeing all those aides and nurses who are foolishly pushing able-bodied men and women who must feel equally foolish in not being permitted to walk for themselves. You’ll save lots of time, money and effort.
Do something about those humiliating robes given to patients undergoing tests. Who designed them? What purpose do they serve other than to make things convenient for the staff? Their design is a perfect example of putdownship. The patient is made to feel inferior…. When people talk about hating hospitals, I can think of no better reason to do so. Redesign those robes with the patient in mind instead of the doctor’s convenience.
Don’t call patients by their first names unless they ask you to do so. I can only wonder with astonishment at the insensitivity of a 25-year-old nurse calling a 70-year-old woman by her first name, especially when the patient is flat on her back, obviously in discomfort, and demonstrating every sign of waiting to die. Surely, asking hospital doctors and nurses to give all patients the dignity of their last names preceded with the appropriate title of Mr., Mrs., or Miss is not too much to ask.
Tell the doctor to slow down. Why should I be scuffled from the waiting room to an inside cubicle designed so that the doctor need not sit down? If he doesn’t sit, there is no reason for him to tarry while answering my questions. When people complain that doctors don’t listen or they are too busy to explain the nature of our illness and to address our fears concerning it, they do not speak of the doctor’s inability to communicate. Doctors are able to communicate if they wish to do so. But they do not because they are too busy, running into one cubicle, then another, listening to the patient, cutting him short because they have all the information they think they need (until they order tests which is a convenient way to avoid thinking).
Don’t keep the patient waiting. If I don’t wait in my lawyer’s office, why must I wait in my doctor’s? Two weeks ago I waited four hours for a test taking three minutes to administer. I waited so long because there was only one nurse on the floor who knew how to do the test (which my high school son could have been taught in five minutes).
To read the full essay from Mr. Ragan, click here.
A secret shopper may be lurking in the waiting room. (Erik S. Lesser for The New York Times)
The nation’s leading doctor group has temporarily shelved a plan to allow so-called “secret shoppers” to monitor patient care in hospital waiting rooms and doctors’ offices.
The proposal was being considered by the policy-making arm of the American Medical Association. The group’s Council on Ethical and Judicial Affairs asked the A.M.A.’s House of Delegates to endorse the practice as a way to help doctors improve patient care. But after hearing testimony from its members during a meeting yesterday in Chicago, the group referred the measure back to a committee. Read more…
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at well@nytimes.com.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
